Spinal Cord and Brainstem Syndromes Flashcards
Fluorosis
Exposure to high levels of flurine or fluroide –> calcification of spinal longitudinal ligaments –> spinal stenosis
Spondylosis
arthritic degeneration of vertebrae that narrows intervertebral foramina
New bone formation can grow into spinal canal –> spinal stenosis
Most disk herniations occur in ___ and ___
Cervical: C6/7
Lumbar: L4/5 and L5/S1
Herniation in cervical region affects:
Nerve emerging from corresponding intervertebral foramina
C6/C7 herniation affect root C7
Herniation of lumbar region affects:
Root corresponding to the lowest of the two vertebra forming the point
L5/S1 affects root S1
Extrinsic lesion of cord compressing laterally will affect ____ first
Will cause _____ which will appear to (ascend/descend)
Sacral levels
Loss of pain/temp and motor paresis
Ascend
Intrinsic lesion originating within spinal cord will affect ____ first, resulting in ____
Upper limb first
Sacral sparing
Brown-Sequard syndrome describes ____
motor and sensory signs resulting from a left or right hemisection of the spinal cord
Central cord syndromes result from ____
Characterized by _____
Lesion developing within spinal cord itself
Bilateral loss of pain and temp over limited area w/ sacral sparing
Disproportionately greater motor impairment in upper compared to lower extremities
Syringomyelia is _____
Destroys _____
Causes ____
Longitudinal cavity that forms in cervical spinal cord
Ventral white commissure
Bilateral loss of pain and temp over shoulder and lateral surface of arm (Cape like sensory loss)
Damage medial (upper limb) portions of lateral corticospinal tract
Anterior cord (spinal artery) syndrome causes: (2) Spares:
- Complete bilateral motor paralysis below lesion
- Complete bilateral loss of pain and temp sensation below lesion
Spares: 2 pt discrimination, vibration sense and kinesthesia
Posterior cord syndrome is characterized by:
Loss of 2 pt discrimination, vibration and kinesthesia
Positive Romberg sign (pt falls when eyes are shut)
Most common cause of posterior cord syndrome
Pts will have:
Syphilis --> cell death in DRG Gait problems (locomotor ataxia) caused by loss of proprioception and damage to corticospinal system
Cauda equina syndrome leads to _____
Signs: (5)
Spinal stenosis affecting dorsal and ventral roots forming cauda equina
Signs:
1. Weakness of leg and foot (LMN signs)
2. Saddle anesthesia: loss of pain/temp, 2 pt, touch over S1-S5 dermatomes
3. Loss of knee and ankle reflexes: damage to ventral roots
4. Urinary retention: Roots S3 and 4
5. Loss of tone in external anal sphincter: Damage to S3-S5
Conus medullaris syndrome signs
Bladder, bowel, sexual dysfunction
UMN signs
Sensory loss confined to perianal region (S4,5)
Lesions in autonomic neurons at or above T2 result in (ipsilateral/contralateral) ____
ipsilateral
Horner’s syndrome
Lesions in sacral autonomic neurons between levels ____ result in ____
S2-S4
Bladder and bowel dysfunction
Corticospinal tract lesions produce ____ signs
Upper motor neuron signs
Ventral horn lesions produce ____signs
Lower motor neuron signs
Blood supply to medulla (4)
Anterior spinal artery: paramedian territory of medulla
Posterior spinal artery
Vertebral artery: lateral medulla
Posterior inferior cerebellar artery: dorsal lateral medulla
Medial medullary syndrome results from ____
occlusion of anterior spinal artery
Lateral medullary syndrome results from ____
occlusion of vertebral artery or PICA
Medial medullary syndrome
Major structures affected and resulting signs: (3)
- Pyramid: contralateral UMN signs with sparing face
- Hypoglossal n./nerve: Ipsilateral LMN sign. Tongue deviates to lesioned side (loss of genioglossus)
- Medial lemniscus: Contralateral 2 pt discrimination, vibration sense and kinesthesia of whole body
Lateral medullary syndrome (Wallenberg’s syndrome, PICA syndrome)
Major structures affected and resulting signs: (7)
- Nucleus ambiguus: Dysphagia (difficulty swallowing), Displaced uvula (levator palati), Flaccid vocal fold (near midline)
- Spinal n. and tract of V: Ipsilateral loss of pain and temp on face
- Spinothalamic tract: Contralateral loss of pain/temp of body
- Hypothalamospinal tract: Horner’s syndrome
- Inferior cerebellar peduncle: ipsilateral ataxia
- Vestibular nuclei: vertigo, nausea
- Reticular formation: hiccups
Caudal pontine AICA infarct
Similar to PICA infarct
Caudal pontine basilar paramedian infarct
- Abducens nucleus: lack of conjugate gaze
- Facial paralysis
- Medial lemniscus: contralateral tactile sensation from whole body
- Pyramid: Contralateral UMN signs
Rostral pontine AICA infarct
- Motor nucleus of 5: mm. of mastication
- Spinal tract and nucleus: Main sensory of face
- Discriminative touch of face
- Spinothalamic tract from body: pain/temp
- Lower extremities tactile touch: lateral medial lemniscus
Rostral basilar paramedian infarct
Upper extremities tactile touch: medial medial lemniscus
Tectospinal tract
Pseudobulbar palsy caused by:
Results in:
Symptoms: (3)
Bilateral interruption of corticobulbar fibers to cranial nerve motor nuclei
Result is: UMN weakness of muscles supplied by affected cranial n. nuclei
Symptoms: Speech problems, dysphagia, inappropriate outburst of laughter and crying
Locked in syndrome results from ____
Damage to _____
Spared ____
Large lesions of basal pons
Corticospinal and corticobulbar pathways bilaterally
Somatosensory pathways and reticular formation –> awake and aware of surroundings
Vascular supply to midbrain (5)
Superior cerabellar a.
Collicular branches of basilar a.
Paramedian branches of basilar a. (caudal)
Posterior choroidal branch of posterior cerebellar a. (rostral)
Branches of post. communicating a. (rostral)
Weber’s Syndrome: results from ____
Major structures affected and signs: (3)
Lesions involving basal midbrain
CN 3 : ipsilateral down and out
Corticobulbar and corticospinal fibers: contralateral UMN
Benedikt’s Syndrome: results from ___
Major structures affected and signs: (6)
Lesions involving midbrain tegmentum
CN3: ipsilateral down and out
Cerebellothalamic fibers/red nucleus: course tremor on movement
Subtantia nigra: resting tremor
Medial/Spinal/Tigeminal lemniscus: contralateral tactile, pain/temp of face and body
